Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-23T00:58:18.203Z Has data issue: false hasContentIssue false
  • English
  • Français

An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities

Published online by Cambridge University Press:  05 December 2011

Tanya E. Davison ,
John Snowdon ,
Nathan Castle ,
Marita P. McCabe ,
David Mellor ,
Gery Karantzas  and
Janelle Allan
Tanya E. Davison*
Affiliation:
Deakin University, Melbourne, Victoria, Australia
John Snowdon
Affiliation:
Discipline of Psychiatry, Sydney Medical School, Concord Hospital, Sydney, New South Wales, Australia
Nathan Castle
Affiliation:
Deakin University, Melbourne, Victoria, Australia
Marita P. McCabe
Affiliation:
Deakin University, Melbourne, Victoria, Australia
David Mellor
Affiliation:
Deakin University, Melbourne, Victoria, Australia
Gery Karantzas
Affiliation:
Deakin University, Melbourne, Victoria, Australia
Janelle Allan
Affiliation:
Deakin University, Melbourne, Victoria, Australia
*
Correspondence should be addressed to: Dr Tanya Davison, School of Psychology, Faculty of Health, Deakin University, Burwood, Melbourne, VIC 3125, Australia. Phone: +61-(0)3-9244-6505; Fax: +61-(0)3-9244-6858. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.

Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument.

Results: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9–13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change.

Conclusions: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.

Keywords

long-term careassessmentscreeningmood disordersresidential/nursing care
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 4 , April 2012 , pp. 631 - 641
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988a). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988b). Use of the Cornell Scale in nondemented patients. Journal of the American Geriatrics Society, 36, 230–236.CrossRefGoogle ScholarPubMed
American Geriatrics Society and American Association for Geriatric Psychiatry (2003). Consensus statement on improving the quality of mental health care in U.S. nursing homes: management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 52, 1287–1298.Google Scholar
Australian Institute of Health and Welfare (2009). Residential Aged Care in Australia 2007–08, Report No. 28. Available at: http://www.aihw.gov.au/publications/index.cfm/title/10709; accessed February 17, 2011.Google Scholar
Barca, M. L., Selbæk, G., Laks, J. and Engedal, K. (2008). The pattern of depressive symptoms and factor analysis of the Cornell Scale among patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 23, 1058–1065.CrossRefGoogle ScholarPubMed
Brühl, K. G., Luijendijk, H. J. and Muller, M. T. (2007). Nurses' and nursing assistants' recognition of depression in elderly who depend on long-term care. Journal of the American Medical Directors Association, 8, 441–445.CrossRefGoogle ScholarPubMed
Cohen, C. I., Hyland, K. and Kimby, D. (2003). The utility of mandatory depression screening of dementia patients in nursing homes. American Journal of Psychiatry, 160, 2012–2017.CrossRefGoogle ScholarPubMed
Commonwealth of Australia (2007). Aged Care Funding Instrument (ACFI): Assessment Pack. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-assessment-pack.htm; accessed February 17, 2011.Google Scholar
Conn, D. K. et al. (2006). National guidelines for seniors' mental health: the assessment and treatment of mental health issues in long-term care homes. Canadian Journal of Geriatrics, 9, S59–S64.Google Scholar
Davison, T. E. et al. (2007). The prevalence and recognition of depression among aged care residents with and without cognitive impairment. Aging and Mental Health, 11, 82–88.CrossRefGoogle ScholarPubMed
Davison, T. E., McCabe, M. P. and Mellor, D. (2009a). An examination of the “gold standard” diagnosis of major depression in aged-care settings. American Journal of Geriatric Psychiatry, 17, 359–367.CrossRefGoogle ScholarPubMed
Davison, T. E., McCabe, M. P., Mellor, D., Karantzas, G. and George, K. (2009b). Knowledge of late life depression: an empirical investigation of aged care staff. Aging and Mental Health, 13, 577–586.CrossRefGoogle ScholarPubMed
Koopmans, R. T. C. M., Zuidema, S. U., Leontjevas, R. and Gerritsen, D. L. (2010). Comprehensive assessment of depression and behavioral problems in long-term care. International Psychogeriatrics, 22, 1054–1062.CrossRefGoogle ScholarPubMed
Kurlowicz, L. H., Evans, L. K., Strumpf, N. E. and Maislin, G. (2002). A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population. American Journal of Geriatric Psychiatry, 10, 600–608.CrossRefGoogle Scholar
McCabe, M. P. et al. (2006). Depression among older people with cognitive impairment: prevalence and detection. International Journal of Geriatric Psychiatry, 21, 633–644.CrossRefGoogle ScholarPubMed
McCabe, M. P., Davison, T. E., Mellor, D. and George, K. (2008). Knowledge and skills of professional carers working with older people with depression. Aging and Mental Health, 12, 228–235.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Griffith, J. and McSweeney, K. (2010). Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia. International Psychogeriatrics, 22, 1149–1153.CrossRefGoogle ScholarPubMed
Pachana, N. et al. (2010). Screening for mental disorders in residential aged care facilities. International Psychogeriatrics, 22, 1107–1120.CrossRefGoogle ScholarPubMed
Phillips, C. J. and Henderson, A. S. (1991). The prevalence of depression among Australian nursing home residents: results using draft ICD-10 and DSM-III-R criteria. Psychological Medicine, 21, 739–748.CrossRefGoogle ScholarPubMed
Rovner, B. W. et al. (1991). Depression and mortality in nursing homes. Journal of the American Medical Association, 265, 993–996.CrossRefGoogle ScholarPubMed
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 1025–1039.CrossRefGoogle ScholarPubMed
Snowdon, J. and Fleming, R. (2008). Recognising depression in residential facilities: an Australian challenge. International Journal of Geriatric Psychiatry, 23, 295–300.CrossRefGoogle ScholarPubMed
Snowdon, J., Rosengren, D., Daniel, F. and Suyasa, M. (2011). Australia's use of the Cornell Scale to screen for depression in nursing homes. Australasian Journal on Ageing, 31, 33–36.CrossRefGoogle Scholar
Soon, J. A. and Levine, M. (2002). Screening for depression in patients in long-term care facilities: a randomized controlled trial of physician response. Journal of the American Geriatrics Society, 50, 1092–1099.CrossRefGoogle ScholarPubMed
Teresi, J., Abrams, R., Holmes, D., Ramirez, M. and Eimicke, J. (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology, 36, 613–620.CrossRefGoogle ScholarPubMed
Warner, J., McCarney, R., Griffin, M., Hill, K. and Fisher, P. (2008). Participation in dementia research: rates and correlates of capacity to give informed consent. Journal of Medical Ethics, 34, 167–170.CrossRefGoogle ScholarPubMed
Watson, L. C., Zimmerman, S., Cohen, L. W. and Dominik, R. (2009). Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. American Journal of Geriatric Psychiatry, 17, 556–564.CrossRefGoogle ScholarPubMed